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Using National Drug Codes (NDCs) on Professional/Ancillary Claims

February 27, 2013

NDC data on claims will play a significant role in 2013. Previous News and Updates and Blue Review articles have emphasized the importance of including NDCs when drugs are billed on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims. 

Currently, Blue Cross and Blue Shield of  Illinois (BCBSIL) requires inclusion of NDCs and related NDC data (qualifier, unit of measure, number of units, price per unit), along with the appropriate HCPCS or Current Procedural Terminology (CPT®) code(s) on claim submissions for unlisted or “Not Otherwise Classified” (NOC) physician-administered/supplied drugs. In addition, use of NDCs has been required for all home infusion therapy (HIT)/specialty pharmacy providers since October 2010. 

Recently, an NDC pricing pilot was conducted to test effectiveness of system enhancements from a provider perspective. The pilot was successful and NDC pricing will be implemented for professional/ancillary claims with dates of service beginning June 1, 2013. As of the June 1, 2013, NDC pricing effective date, professional/ancillary claims for drugs must include NDC data in order to be accepted for processing by BCBSIL. 

For general information to assist you with using NDCs on electronic (837P) and paper (CMS-1500) claims, refer to the NDC Billing Guidelines  in the Claims and Eligibility/Claim Submission section. 

Please check the News and Updates section, as well as upcoming issues of the Blue Review for additional NDC announcements and related resources. 

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